Have you had to have a Ureteral Stent? Let's talk about this simply! (Ureteral Stent)

Maybe your doctor has told you that you have a kidney stone. Or maybe you are feeling uncomfortable because of a blockage in your urinary tract. At a time like this, it is normal to feel a little scared and nervous when your doctor tells you that you need to have a stent inserted. But don't worry, today we are going to talk about what a ureteral stent is, what it does, and how it feels when you have it in place.

What is a Ureteral Stent?

Simply put, this is a very thin, flexible tube made of silicone or plastic. Our body has two thin tubes that carry urine from the kidneys to the bladder, which we call ureters. This stent is used to keep it open when there is a blockage or blockage in one of those ureters.

Just like when a water pipe gets clogged with dirt, the water stops flowing. When our urethra gets clogged, urine cannot pass from the kidney to the bladder. What this stent does is insert this thin tube inside the clogged passage, creating a path for urine to flow through without any obstruction.

This stent is about 10 to 15 inches long. The doctor inserts it so that the coil at the top end is inside the kidney and the coil at the bottom end is inside the bladder. These two coils keep the stent in place without moving around. Some people also call this a 'Double-J stent.'

Why do you need to insert this stent?

The main reason is to avoid any obstruction to the flow of urine and to transport the urine to the bladder without damaging the kidneys. There can be a number of reasons for this.

What preparations need to be made before the stent is placed?

Since this is a surgery, your doctor will give you some instructions before it. It is very important to follow these instructions exactly.

• Your complete health history: Tell your doctor everything you have, including any other illnesses you have had, and any previous surgeries you have had.
• Medications you take: It is very important to tell your doctor about all the medications you are taking, including vitamins and herbal remedies. Some medications (such as blood thinners) can increase the risk of bleeding during surgery.
• Allergies: If you have any allergies to any medicine or food, be sure to mention it.
• Blood tests: You may be asked to do some blood tests, such as eGFR, to see if your kidneys are functioning properly.
• Fasting: You will be asked to stop eating or drinking for about 8 hours before surgery. However, if you have any essential medication, ask your doctor if it can be taken with a sip of water.

Is this a major operation?

No, most of the time this is a simple surgery, without any major incisions or cuts. Doctors call it 'minimally invasive'. That means there is minimal damage to the body. You can often go home the same evening. But because you are under anesthesia, it is essential that someone comes to take you home.

What happens when a stent is placed?

This surgery is performed by a urologist. The entire procedure is done under general anesthesia, so you won't feel anything and you'll be sound asleep.

1. Scan: First, the doctor uses a type of X-ray (fluoroscopy) or ultrasound scan to find exactly where the blockage is in the urethra.

2. Insertion of the cystoscope: Next, a thin, long tube with a camera attached (a `cystoscope`) is inserted through your urethra and into your bladder.

3. Insertion of the stent: Next, a very thin wire (`guidewire`) is passed through the `cystoscope` into the blocked urethra. The stent is then guided along that wire to the correct location.

4. Finishing: Once the stent is properly placed, the wire and the cystoscope are removed. Only the stent remains inside.

The entire procedure takes less than 30 minutes, but you will need to stay in the hospital for several hours, including time to prepare for the surgery, recover after the surgery, and make sure you are okay.

What can you expect after stent placement?

When you wake up from anesthesia, you will feel a little sluggish and drowsy. You will be given medication to control the pain.

• Blood in the urine (hematuria): It is completely normal to have a little blood in the urine and a pinkish tinge to it for the first few days. Don't worry about it. It will gradually subside over a few days. However, you may still see a little blood until the stent is removed.
• Discomfort and pain: You may feel a slight burning or pain (`dysuria`) when urinating. You may also feel the need to urinate more frequently.
• Drink plenty of water: Your doctor will tell you to drink plenty of water for a few days. This will help your kidneys and bladder function.

How long should the stent be left in place? How do I remove it?

Most of the time, a stent is temporary . Your doctor will remove it after the problem in your urethra (e.g., the stone is removed, the swelling goes down) has resolved. It is usually left in place for a few days to a few weeks.

But for some people, for example, if the urethra is blocked by a tumor, it may need to be left in place for months, or even years. For those people, the old stent is removed and a new one is inserted every 3-6 months to prevent infections (UTIs).

Does it hurt to have the stent removed?

There are two ways to remove the stent.

1. Stent with a thread: Some short-term stents have a small thread at the end. It comes out of the urethra. The doctor pulls the thread gently and removes the stent. This is a quick procedure.

2. Threadless stents: Stents that have been in place for several weeks or longer do not have a thread. They are removed in a small procedure done in the doctor's office. First, a numbing solution is applied to the area, a cystoscope is inserted, and the stent is removed with a small forceps. The numbing does not cause much pain. However, there may be some discomfort and pain for a few days after the numbing is gone.

What can be done about the problems and pain that occur while having a stent?

Unfortunately, about 80% of people who have a stent will experience some minor discomfort. These are usually not serious.

• Bladder irritation
• Frequent need to urinate
• Pain or burning when urinating
• Slight blood in the urine
• Increased risk of urinary tract infections (UTIs)

Why does it hurt so much when I have a stent in place?

This is not the same for everyone. Some people may only feel a little discomfort, while others may feel more pain. The main reason is that when you urinate, the bladder contracts. Then the coil inside the stent rubs against the wall of the bladder. That's why some people feel pain.

What can be done to reduce pain?

• Painkillers: You can use paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. ibuprofen). But never take any painkillers without consulting your doctor .
• Special medications: Sometimes your doctor will prescribe a medication like tamsulosin. Although these are actually medications given to men for prostate problems, they can help a lot with the pain and discomfort caused by the stent.

When should you call the doctor?

While minor discomfort is normal when having a stent, if you experience any of the following symptoms, call your doctor immediately or go to the hospital's Emergency Department (ETU).

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